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Diabetes

Poster Session 2

(403) Associations between diabetic keto acidosis and adverse neonatal outcomes in those with pre-gestational diabetes

Tuesday, February 13, 2024
3:30 PM – 5:00 PM  
Location: Prince George's Exhibit Hall CDE, Lower Atrium Level
Objective: Type 1 diabetes (T1D) and type 2 diabetes (T2D) have been associated with increased neonatal morbidity in pregnancy. Specifically, diabetic ketoacidosis (DKA) during pregnancy can cause significant adverse perinatal outcomes, however, the impact of a DKA diagnosis in pregnancy on neonatal outcomes unknown.

Study Design: This is a retrospective cohort study of California linked hospital discharge-vital statistics data from 2008-2019. We included singleton, live-born infants with gestational age of 23-42 weeks in those with pre-gestational diabetes. We compared neonatal outcomes in pregnancies of individuals with T1D and T2D who received a diagnosis of DKA during pregnancy to those who did not. Chi-squared and multivariable logistic regression were utilized for statistical analyses.

Results: A total of 7,401 pregnancies with T1D and 38,062 pregnancies with T2D were included, of which 786 (10.6%) and 703 (1.9%) had DKA during the pregnancy, respectively. Although not significant between the groups, those with T1D had high rates of NICU admission both with or without a diagnosis of DKA in pregnancy (33.4 vs 22.5%).  Among those with Type 2D, a diagnosis of DKA in pregnancy was associated with NICU admission (aOR: 1.62; 95% CI: 1.35, 1.95), respiratory distress syndrome (aOR: 1.33; 95% CI: 1.01, 1.75) and large for gestational age infants (aOR: 1.32; 95% 1.27, 1.80) as compared to those without DKA.

Conclusion: Our study suggests that in those with T2D, DKA in pregnancy significantly increases the risk of adverse neonatal outcomes. Although the findings were not significant for T1D, there are still high rates of NICU admission.  This may suggest that the effect of DKA on placental function may vary for T1D and T2D.